| NPI | 1194012328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016005625) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 1055-25) |
| 213E00000X Podiatrist (Licence: IN 07001270A) | |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2018-02-23 |